Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-21T13:51:44.681Z Has data issue: false hasContentIssue false
  • English
  • Français

Case-Series Evaluating a Transdiagnostic Cognitive-Behavioural Treatment for Co-occurring Anxiety Disorders

Published online by Cambridge University Press:  03 November 2014

Freda McManus ,
Gavin Clark ,
Kate Muse  and
Roz Shafran
Freda McManus*
Affiliation:
University of Stirling, Scotland
Gavin Clark
Affiliation:
University of New England, Australia
Kate Muse
Affiliation:
University of Worcester, UK
Roz Shafran
Affiliation:
UCL Institute of Child Health, London
*
Reprint requests to Freda McManus, University of Stirling, Stirling FK9 4LA, Scotland. E-mail: f.v.mcmanus@stir.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioural interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating co-occurring anxiety disorders. Aims: To evaluate the efficacy of a transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders. Method: An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13-session modular transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results: Five of the six participants completed treatment. At posttreatment assessment the five treatment completers achieved diagnostic and symptomatic change, with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the 3-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre to postintervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at 3-month follow-up. Conclusions: Results suggest that transdiagnostic cognitive behavioural interventions can be of benefit to patients with co-occurring anxiety disorders.

Keywords

Anxiety disorderco-morbidtransdiagnosticcognitive behavioural treatmentcase-series
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 6 , November 2015 , pp. 744 - 758
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev). Washington, DC: Author.Google Scholar
Arch, J. J., Ayers, C. R., Baker, A., Almklov, E., Dean, D. J. and Craske, M. G. (2013). Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behaviour Research and Therapy, 51, 185–196.Google Scholar
Baker, T. B., McFall, R. M. and Shoham, V. (2009). Current status and future prospects of clinical psychology: toward a scientifically principled approach to mental and behavioral health care. Psychological Science in the Public Interest, 9, 67–103.Google Scholar
Barlow, D. H., Allen, L. B. and Choate, M. L. (2004). Towards a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.Google Scholar
Barlow, D. H. and Hersen, M. (1984). Single Case Experimental Designs: strategies for studying behavior change (2nd ed.). Boston, MA: Allyn and Bacon.Google Scholar
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Borckardt, J. J., Nash, M. R., Murphy, M. D., Moore, M., Shaw, D. and O’Neil, P. (2008). Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis. American Psychologist, 63, 77.Google Scholar
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. and Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.Google Scholar
Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: a 12-year prospective study. American Journal of Psychiatry, 162, 1179–1187.CrossRefGoogle ScholarPubMed
Clark, D. M. (2004). Developing new treatments: on the interplay between theories, experimental science and clinical innovation. Behaviour Research and Therapy, 42, 1089–1104.Google Scholar
Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Gray, N., Waddington, L., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.Google Scholar
Clark, L. A. and Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.CrossRefGoogle ScholarPubMed
Cox, B. J., Cohen, E., Direnfeld, D. M. and Swinson, R. P. (1996). Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? Behaviour Research and Therapy, 34, 949–954.Google Scholar
Craske, M. G. (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety, 9, 749–753.CrossRefGoogle Scholar
Craske, M., Farchione, T. J., Allen, L. B., Barrios, V., Stoyanova, M. and Rose, R. (2007). Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more? Behavior Research and Therapy, 45, 1095–1109.Google Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., et al. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessment as early interventions for PTSD. Archives of General Psychiatry, 60, 1024–1032.CrossRefGoogle Scholar
Evans, C., Margison, F. and Barkham, M. (1998). The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence Based Mental Health, 1, 70–72.Google Scholar
Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Audin, K., Connel, J., et al. (2000). CORE: Clinical Outcomes in Routine Evaluation, Journal of Mental Health, 9, 247–255.Google Scholar
Fairburn, C. G., Cooper, Z. and Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.Google Scholar
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., et al. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy, 43, 666–678.Google Scholar
First, M. B., Spitzer, R.L., Gibbon, M. and Benjamin, A. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) - Clinician Version. Washington, DC: American Psychiatric Publishing.Google Scholar
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R. and Hajcak, G. (2002). The obsessive-compulsive inventory: development and validation of a short version. Psychological Assessment, 14, 485–496.Google Scholar
Harvey, A., Watkins, E., Mansell, W. and Shafran, R. (2004). Cognitive Behavioural Processes across Psychological Disorders: a transdiagnostic approach to research and treatment. Oxford: Oxford University Press.Google Scholar
Hofmann, S. G. and Smits, J. A. J. (2008). Cognitive-behavioural therapy for adult anxiety disorders: a metaanalysis of randomized placebo controlled trials. Journal of Clinical Psychiatry, 69, 621–632.Google Scholar
Houck, P. R., Spiegel, D. A., Shear, M. K. and Rucci, P. (2002). Reliability of the self-report version of the PDSS-SR. Depression and Anxiety, 15, 183–185.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Behavior Therapy, 17, 305–308.Google Scholar
Johnston, L., Titov, N., Andrews, G., Dear, B. F. and Spence, J. (2013). Comorbidity and internet-delivered transdiagnostic cognitive behavioural therapy for anxiety disorders. Cognitive Behaviour Therapy, 42, 180–192.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Delmer, O. and Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey Replication. Archives of General Psychiatry, 62, 617–627.Google Scholar
Lobbestael, J., Leurgans, M. and Arntz, A. (2011). Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clinical Psychology and Psychotherapy, 18, 75–79.Google Scholar
McEvoy, P. M. and Nathan, P. (2007). Effectiveness of cognitive behavior therapy for diagnostically heterogeneous groups: a benchmarking study. Journal of Consulting and Clinical Psychology, 75, 344–350.Google Scholar
McManus, F. and Shafran, R. (2014). Transdiagnostic approaches for anxiety disorders. Chapter 7 in Whittington, A. and Grey, N. (Eds.), How to Become a More Effective CBT Therapist: mastering metacompetence in clinical practice. Oxford: Wiley Blackwell.Google Scholar
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.Google Scholar
NICE (2011). Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in adults (Clinical Guideline 113). London: National Institute for Clinical Excellence. Retrieved from www.nice.org.ukGoogle Scholar
NICE (2013). Social Anxiety Disorder: recognition, assessment and treatment of social anxiety disorder (Clinical Guideline 159). London: National Institute for Clinical Excellence. Retrieved from www.nice.org.ukGoogle Scholar
Norton, P. J., Barrera, R. L., Mathew, A. R., Chamberlain, L. D., Szafranski, D. D., Reddy, R., et al. (2013). Effect of transdiagnostic CBT for anxiety disorders on comorbid diagnosis. Depression and Anxiety, 30, 168–173.Google Scholar
Parsonson, B. S. and Baer, D. M. (1992). The visual analysis of data, and current research into the stimuli controlling it. In Kratochwill, T. R. and Levin, J. R. (Eds.), Single-Case Research Design and Analysis: new directions for psychology and education (pp. 15–40). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., et al. 2009). Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902–909.Google Scholar
Shafran, R., McManus, F., Cooper, Z. and Clark, G. (2008 ). A Transdiagnostic Approach to the Understanding and Treatment of Anxiety Disorders: treatment protocol. Unpublished manuscript.Google Scholar
Stobie, B., Taylor, T., Quigley, A., Ewing, S. and Salkovskis, P.M. (2007). “Content May Vary”: a study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy, 35, 273–282.Google Scholar
Turner, S. M., Beidel, D. C., Dancu, C. V. and Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: the Social Phobia and Anxiety Inventory. Psychological Assessment, 1, 35–40.Google Scholar
Submit a response

Comments

No Comments have been published for this article.